nysdoh - division of nutrition - bureau of nutrition risk

Project Director Name:

Total Funding Request:

Email Address:

Phone:Address:

Applicant Organization Name:

Please ensure that the following application is completed in its entirety. Applications must be typed and submitted by the deadline on the first page of the RFA. Handwritten applications will not be accepted. The applicant is responsible for ensuring that the typed responses are visible in the space provided. Incomplete applications may not be considered for funding.

NYSDOH - Division of Nutrition - Bureau of Nutrition Risk Reduction Hunger Prevention and Nutrition Assistance Program (HPNAP)

RFA #1003220225

Food Recovery Project Application

Gleaning Prepared Food Recovery Perishable Food Recovery

Please submit the following eligibility documents:

A copy of the Certification of Incorporation, documenting your agency's incorporation status

A copy of the US Dept. of Treasury, Internal Revenue Service correspondence stating your agency's Federal Tax ID number.

A copy of your agency's New York State Department of State form which indicates your charity registration number.

Audited Financial Statements

501 c 3

County

of 15

I hereby attest to the above applicant organization having a minimum of 12 months experience providing the services described in this application. Printed Name:_____________________________Signature:___________________________________

Project Director Signature:

Please check the type(s) of program you are applying for. Please refer to pages 6-7 of the RFA for program descriptions:

Text

e

d

A. Project Summary Maximum 10 Points

A1. Clearly describe the project or service for which you are requesting funding and the target or catchment areas.

of 15

Text

e

d

A2. Describe your organizations experience in providing the proposed service. Highlight your accomplishments in providing services for persons needing food assistance. Include how minorities, Lesbian/Gay/Bisexual/Transgender persons and persons with disabilities are incorporated into the development and implementation of services.

A. Project Summary continued

of 15

Text

e

d

A3. Describe additional resources your agency will provide to support or contribute to the success of the proposal (e.g. matching or other funding, in-kind donations or volunteer support, outreach services, etc.).

A. Project Summary continued

of 15

B. Description of Need Maximum 15 Points

Text

e

d

B1. Describe social, economic and/or other indicators of need in the target area such as unemployment levels, poverty statistics, etc. that demonstrate a need for emergency food assistance. Include a description of the lack or inadequacy of existing emergency food relief services available to the target area.

Text

e

d

B2. Describe the methods and type of data used to identify the target population and estimate the number of persons in need of emergency food assistance. Include the basis for your estimate.

of 15

B. Description of Need continued

Text

e

d

B3. Describe the extent to which the proposed project will address the described un-met need. Be precise as to how your agency will provide services which exceed or may compliment other services in the catchment area.

of 15

C. Applicant Organization Maximum 20 Points

Text

e

d

C1. Include (as Attachment C1) a description or diagram of the organizational structure of your agency and a listing of your Board of Directors. The organizational chart should include hierarchy within your agency and parent organization (if applicable); key positions and staff associated with your emergency food relief services; and names, positions, address, and phone numbers of your Board of Directors. Organization structure should be conducive to providing quality services.

Included as Attachment C1 Not Included

C2. Describe your organizations current relationship to the target community. Include (as Attachment C2) letters of cooperation and collaboration and/or letters of support that verify the current or requested services and demonstrate partnerships that will support the proposed project. Include no more than 20 letters total. Included as Attachment C2 Not IncludedC3. List names and addresses of potential donors of wholesome, donated food; that include local farms, community gardens, correctional facilities, food companies and establishments, etc. that demonstrate partnerships that will support the proposed project.

of 15

Text

e

d

C4. List here or include as Attachment C4, the Emergency Food Relief Organizations that may receive food from your organization. Include addresses and catchment areas.

C. Applicant Organization continued

Text

e

d

C5. List the applicant organizations major funding (sources providing 20% or more of total funding). The list of major funding sources should demonstrate the viability of your organization. Funding sources will be reviewed to assist in determining the viability of your organization.

of 15


Text

e

d

C6. List required Food Safety certifications held by your organization (e.g. National Restaurant Assocation's ServSafe certification or local Department of Health Operating or Food Handlers Certificate.)

Text

e

d

C7. Provide your organization's Mission and Vision Statements below or include as Attachment C7. Describe how they are consistent with HPNAP Mission and Vision.

of 15


Text

e

d

C8. Describe your cost containment and/or purchasing policies and procedures.

of 15

D. Project Activities Maximum 25 Points

Text

e

d

D1. Describe the plan for how the proposed service will be provided as well as service goals with measurable objectives including projected service level (# of pounds). Also describe the kinds and amounts of work and project activities to be accomplished over the course of the year for each objective listed. Provide details of partnerships or collaborations that enhance the stability of the project. Goals should be reasonable.

of 15

Text

e

d

D2. Describe how the project will provide services that increase the availability of produce and/or other fresh, whole, high-quality, nutrient dense foods in the catchment area.

D. Project Activities continued

Text

e

d

D3. Described the project service goals with measurable objectives. Estimate the pounds of food types received and distributed that will benefit low income families and individuals. Proposed service goals are realistic and achievable.

of 15

Text

e

d

D4. Describe how the Food Safety and Sanitation Project will be administered in order to ensure the distribution of safe food.

D. Project Activities continued

Text

e

d

D5. Provide the plan for submitting monthly reports to the State regarding progress in meeting the goals and objectives of this project.

of 15

E. Project Evaluation Maximum 10 Points

Text

e

d

E1. Describe how the proposed service will be evaluated to determine that progress is being made and objectives are being met. Include the methods, design and timeframe.

of 15

F. Budget Maximum 20 Points Applicants should keep in mind that Program funds are limited and that the cost effectiveness of an organization's proposal will directly impact the scoring of this section. The budget request should identify only those allowable costs that are necessary to provide proposed services. Scoring will be based on the budget's clarity, completeness and feasibility of providing a quality service with the funds requested. Final budgets and work plans will be determined when HPNAP contracts are established.

F1. Complete and include the budget package (Attachment #8). Include a justification below for each cost or include it as Attachment F1 (up to 3 additional pages, if needed.) Justifications must fully explain the intent of the funding for the budget category as well as how the amount was computed. For all existing staff, the Budget Justification must delineate how the percentage of time devoted to this initiative was determined. Include job descriptions as Attachment F1.

Text

e

d

of 15

nysdoh - division of nutrition - bureau of nutrition risk

Documents